Understanding Post-Acute-Withdrawal Syndrome (PAWS)

Post-acute-withdrawal syndrome (PAWS) is a set of persistent impairments that occur after withdrawal from alcohol, opiates, benzodiazepines, and other substances. If an individual is chemically dependent on drugs or alcohol, then he or she will experience withdrawal symptoms starting a few hours after he or she quits their drug of choice. These symptoms are called acute withdrawal symptoms and may include shaking, chills, nausea, and vomiting. PAWS may occur after the initial withdrawal period; usually 7 to 14 days post-withdrawal.

PAWS impacts many aspects of life in recovery. More than 90% of people withdrawing from a long-term opiate dependency, such as heroin or prescription painkillers, will experience symptoms of PAWS. Around 75% of those withdrawing from alcohol, benzos, and methamphetamine will experience the symptoms.

Post-acute-withdrawal syndrome or post-withdrawal syndrome is a result of GABA-agonist dependence (i.e. dependence on drugs which stimulate the GABA receptor in the brain). Long-term substance abuse weakens the brain’s ability to deal with stress because most addicts are using a substance to blot out stressful thoughts or feelings. PAWS may occur due in part to persisting physiological adaptation in the central nervous system, disturbances in neurotransmitters, and hyperexcitability of neuronal pathways. Stressful situations will arise early in sobriety and PAWS can exacerbate the stress. Addiction counselors and therapists work with individuals to help them identify and cope with their triggers for drug or alcohol abuse. This will lessen the amount of unmanageable stress in the individual’s life.

Unfortunately, PAWS can last from a year to several decades, or even indefinitely with periods of remission between periods of PAWS symptoms. Symptoms include extreme mood swings, which may resemble Bipolar Disorder. Other symptoms may include insomnia, anxiety, panic attacks, depression, and suicidal ideation. Many recovering alcoholics appear clumsy and uncoordinated a few weeks after they quit drinking. This is the result of consistent alcohol abuse.

There is good news for those in recovery suffering from PAWS, however. As the time in recovery progresses, the frequency of symptoms will lessen. Most people will start having more good days, but there will be bad days too. Over time, the brain will heal itself from the drug and alcohol addiction and PAWS symptoms may completely disappear.